CPT 86602 Actinomyces Antibody — Reimbursement

CPT code 86602 designates a laboratory immunoassay to detect antibodies to Actinomyces in patient blood. As a specific serologic diagnostic test, it is used to support clinical evaluation of suspected Actinomyces infection or exposure, informing clinical decision-making for infectious disease management. Nationally, accurate coding for such specialized laboratory tests matters for clinical documentation, billing consistency, and laboratory service reporting.

Key payers referenced in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical purpose of the test, typical sites of service, and the common modifiers associated with laboratory billing. The publication summarizes benchmarking context where available, outlines coding and billing considerations relevant to payers named above, and provides clinical context for when the assay is likely to be ordered.

This summary is intended for national audiences including billing professionals, laboratory administrators, and clinical staff seeking a clear understanding of CPT code 86602, its clinical role, and payer coverage context. Data not available in the input will be noted where applicable.

Billing Code Overview

CPT code 86602 describes an immunoassay performed by a laboratory analyst to detect antibodies to Actinomyces in a patient's blood. This test is a serologic diagnostic assay used to evaluate immune response indicative of Actinomyces exposure or infection.

Service type: Laboratory diagnostic immunoassay

Typical site of service: Clinical laboratory or hospital laboratory

Data not available in the input.

Clinical Context

A 45-year-old patient presents to an outpatient laboratory after referral from their primary care physician for evaluation of chronic oral and facial pain with draining sinus tracts and tender submandibular swelling. The clinician documents concern for a possible actinomycotic infection given a history of poor dentition and a persistent jaw mass unresponsive to standard antibiotics. A blood sample is collected via venipuncture in the outpatient laboratory. The laboratory analyst performs an immunoassay to detect antibodies to Actinomyces species (CPT 86602) as part of the infectious disease workup. Results are reported in the laboratory information system and routed to the ordering provider for correlation with culture, imaging, and clinical findings.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician or pathologist’s interpretation and reporting portion of the test separate from the technical component.
`TC`	Technical component	When billing only the laboratory technical portion (assay, equipment, supplies) and not the professional interpretation.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Specialists order and interpret serologic testing for complex infections.
207L00000X	Pathology	Pathologists oversee laboratory testing, interpretation, and reporting.
364A00000X	Laboratory - Allopathic & Osteopathic	Clinical laboratory practitioners perform and manage immunoassays.
207R00000X	Family Medicine	Primary care clinicians frequently order initial serologic testing in outpatient settings.
261QF0401X	Oral and Maxillofacial Surgery	Specialists may order testing when jaw or facial actinomycosis is suspected.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A49.0`	Streptococcal infection of unspecified site	Streptococcal co-infection or differential when evaluating cervicofacial infections; considered in differential diagnosis with Actinomyces.
`A52.7`	Late syphilis of other and unspecified sites	Listed as part of differential for chronic draining sinuses and granulomatous infections in the head and neck region.
`B95.8`	Other staphylococci and streptococci as the cause of diseases classified elsewhere	Coded when specific bacterial pathogens are identified alongside actinomycotic infections.
`K13.2`	Cellulitis and abscess of mouth	Oral and perioral infections that may prompt serologic testing for Actinomyces in persistent or atypical cases.
`L02.91`	Cutaneous abscess, unspecified	Skin and subcutaneous abscesses with draining sinuses that raise suspicion for actinomycosis when chronic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80053`	Comprehensive metabolic panel	Baseline metabolic assessment often ordered alongside serologic testing to assess patient status prior to treatment.
`87070`	Culture, bacterial; any source, aerobic, and anaerobic, with isolation and presumptive identification of isolates	Microbiologic culture of drainage or tissue to attempt definitive isolation of Actinomyces species; often ordered in parallel with serology.
`87075`	Culture, bacterial; anaerobic, with identification	Specific anaerobic cultures that can grow Actinomyces and provide organism identification, complementing immunoassay results.
`88305`	Level IV surgical pathology, gross and microscopic examination	Histopathologic examination of excised tissue or biopsy demonstrating sulfur granules or filamentous bacteria consistent with actinomycosis.
`86485`	Antibody; direct fluorescent antibody (DFA) technique (e.g., viral)	Other immunologic laboratory techniques that may be used for confirmatory or complementary serologic testing.

OpenPayer

Summary & Overview

CPT 86602: Immunoassay for Actinomyces Antibodies